Summary of written evidence
Can these resources reasonably be expected to be provided under present or alternative funding arrangements?
As noted earlier, many of the submissions received clearly supported the continuation of the NHS and the principles upon which it was founded. They also expressed a continuing aspiration that the present system of funding the service should be retained and a belief that with increased levels of public funding the NHS could provide the level of service required by the public. The Long Term Medical Conditions Alliance expressed the view that “All our lives are affected by chronic illness, either personally, as carers, as family members or as employers. We feel that the increased public spending on health care is one which is supported by society and will continue to be so.”
The fundamental objection expressed by several organisations, for example, MIND, to providing resources under alternative arrangements, was the inappropriateness of insurance based systems for many including those suffering long term conditions and mental health problems. These groups would either find it difficult to obtain cover, or needed healthcare which was comprehensive, integrated and multidisciplinary.
Age Concern also made the point that even those who are able to access private healthcare frequently do not do so when their healthcare requirements are immediate or are particularly complex.
The Royal College of Paediatrics and Child Health also argued that a PMI based system would be inappropriate for children “…there is very little private practice in paediatrics when compared with other branches of medicine in the UK, partly because most paediatricians are more comfortable practising in the context of a multi-disciplinary team and partly because by the nature of things people with young children are often those who are least able to afford private health insurance, apart from the most prosperous sector of the community………There is also the difficult question that much paediatric health care these days is related to conditions which are chronic and long term and continue into adult life, so that changes in the health insurance system would present particular problems for that group of patients.”
Others noted that there already existed in the UK a mixed economy of healthcare, tacitly accepted by the public, by which much dental and optical care and long term care which had originally been part of the health/social care package is paid for by individuals. They saw no reason why this system should not continue to exist, with a publicly funded system supplemented by individuals through some degree of co-payment or PMI if required.
The submission from PPP questioned whether the public would accept the increase in general taxation needed to bring expenditure up to French or German levels. It suggested that the overall expenditure on healthcare must come from increased personal expenditure. Also that “There is no reason why the current system of paying for state funded health care from funds raised through general taxation should not continue to be at the core of the way in which health care is funded in this country. Nor is there any reason why additional private funding could not be achieved through appropriate judicious introduction of co-payment for some government funded services.”
PPP also argued the point (later supported in discussion at the first review seminar) that the funding system (ie general taxation) was efficient but the system of delivery was not. “…the key issue that this review should address is that the NHS and Department of Health will never achieve the maximum value from money spent while the role of funding health care is so completely aligned with the direct provision of services.”